RESUMO
OBJECTIVE: Reporting our experience of the management and treatment of Idiopathic granulomatous mastitis (IGM) in a low-income country by describing patients characteristics and therapy with emphasis on conservative surgical excision and postoperative care as the cornerstone of treatment. METHODS: A retrospective cohort of women with histopathological diagnosis of IGM from 2014 to 2018 at Instituto Nacional Materno Perinatal in Lima, Peru. Patients' characteristics, clinical presentation, treatment, management, postoperative care, and follow-up were analyzed. RESULTS: Thirty-eight patients with histopathological diagnosis of IGM were identified. Their average age was 35.9 years and 23 (60.5%) reported previous use of hormonal contraceptives. Nine (23.7%) patients had chronic mastitis with previous treatment. The time from the onset of symptoms to the first clinic consult was 5.1 months on average. Twenty-one (55.3%) patients had the lesion in the right breast, with a mean size of 6.9 cm. Conservative surgical excision was performed in all patients. Additionally, 86.8% required corticosteroids and 78.9% were treated with antibiotics. Complete remission was obtained at 141 days on average (range 44 to 292 days). Six (15.8%) women reported ipsilateral recurrence and 5 (13.2%), contralateral. The latency time was 25.5 months on average. CONCLUSION: The conservative surgical treatment demonstrated and close follow-up made for a high cure rate, but with recurrence similar to that reported in the literature. Use of gloves is an alternative to manage post operative wounds in a low-income country. The most frequent adverse effect was breast surgical scar.
Assuntos
Mastite Granulomatosa , Feminino , Humanos , Adulto , Masculino , Mastite Granulomatosa/diagnóstico , Mastite Granulomatosa/cirurgia , Estudos Retrospectivos , Mama/patologia , Corticosteroides , Imunoglobulina MRESUMO
Idiopathic granulomatous mastitis is a rare inflammatory breast disease of unknown etiology. It manifests as breast mass of 6 cm on average (range 2-10 cm), often in upper outer quadrant of left breast, in another quadrant, right or bilateral breast. Clinical diagnosis by ultrasound or mammography and fine needle aspiration confuses with carcinoma; histopathology (gold standard) confirm the diagnosis after ruling out causes of granulomatous inflammation, mainly tuberculosis. Steroid treatment achieve complete remission, but adverse reactions and relapses after the descent and suspension. Methotrexate or azathioprine is added from the start to maintain remission. We report three cases of idiopathic granulomatous mastitis diagnosis and treatment based on prednisone until clinical improvement and methotrexate as maintenance therapy. Complete remission was obtained in three patients. The rheumatologist knows and handles autoimmune/inflammatory with these drugs, therefore, is suggested the multidisciplinary treatment of this disease with oncologists and gynecologists.
Assuntos
Dexametasona/uso terapêutico , Mastite Granulomatosa/tratamento farmacológico , Metotrexato/uso terapêutico , Prednisona/uso terapêutico , Abscesso/complicações , Abscesso/cirurgia , Adulto , Antituberculosos/uso terapêutico , Neoplasias da Mama/diagnóstico , Terapia Combinada , Dexametasona/administração & dosagem , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Mastite Granulomatosa/complicações , Mastite Granulomatosa/cirurgia , Humanos , Mastectomia Simples , Metotrexato/administração & dosagem , Prednisona/administração & dosagem , Indução de Remissão , Tuberculose/diagnósticoRESUMO
Introdução: A mastite granulomatosa lobular idiopática (MGLI) é uma doença inflamatória crônica rara, benigna e autolimitada, cuja etiologia é desconhecida. A incidência permanece incerta, geralmente acomete mulheres em idade fértil com história recente de gestação e aleitamento. Relato de caso: Paciente com 37 anos, feminina, branca. Referia nodularidade em mama direita associada à dor há três meses. Fez uso de antibiótico por trinta dias sem melhora do quadro. Negava febre ou trauma local, não estava amamentando. Ao exame, palpava-se área endurecida, irregular, com, aproximadamente, 11,Ox12,O cm em quadrante superior interno. À ultrassonografia (US) mamária havia diversas coleções em quadrante superior interno e periareolar. Realizada drenagem de coleções em mama direita, bem como biópsia de parênquima mamário. O anatomopatológico foi compatível com MGLI com formação de abscesso. Conclusão: A MGLI é uma condição inflamatória que pode mimetizar neoplasia e abscesso mamários. Os achados do exame físico e radiológicos são inespecíficos. A histopatologia confirma o diagnóstico na presença de granuloma não caseoso em unidades lobulares. Em virtude da tendência à recorrência e à resolução lenta, seguimento prolongado é indispensável.
Introduction: The idiopathic lobular granulomatous mastitis (ILGM) is a rare chronic inflammatory disease, benign and self-limited, whose etiology is unknown. The incicknce remains uncertain, usually affects women of childbearing age with a recent history of pregnancy and lactation. Case report: A 37-year-old, white woman reported nodularity in the right breast associated with pain ftr three months. She used antibiotic ftr thirty days without improvement. Fever or local trauma was not nursing. On examination, there was hardened and irregular area with approximately 11.Oxl2. 0 em in the upper inner quadrant. At ultrasound (US), breast had several collections in the upper inner quadrant and periareolar. The lesion was biopsied and drained. The pathology was compatible with ILGM with abscess. Conclusion: ILGM is an inflammatory condition that can mimic cancer and breast abscess. The findings of physical examination and radiological findings are nonspecific. Histopathology confirms the diagnosis in the presence of noncaseating granuloma in lobular units. Given the tendency to recurrence and slow recovery, extenckd ftllow-up is essential.
Assuntos
Humanos , Feminino , Adulto , Granuloma/patologia , Mastite Granulomatosa/cirurgia , Mastite Granulomatosa/terapia , Aleitamento Materno , GestantesRESUMO
La mastitis cónica granulomatosa idiopática es una enfermedad rara que se presenta en mujeres, preferentemente en edad reproductiva, con características clínicas, mamográficas, ecográficas y citológicas sugestivas de cáncer mamario. Se informa un caso de patología mamaria en paciente mujer de 35 años de edad, portadora de tumoración eritematosa, sensible, localizada en mama izquierda. La lesión fue tratada como "mastitis" con antibióticos y corticoides durante dos semanas. La persistencia de tumoración y sensibilidad, así como los controles mamográficos y ecográficos sugestivos de neoplasia, decidieron la extirpación quirúrgica. El diagnóstico histopatológico fue de mastitis crónica granulomatosa idiopática.
Idiopathic chronic granulomatous mastitis is a rare disease in women at the reproductive life with clinic, mammographic, echographic and cytological characteristics suggestive of breast cancer. We report a case of breast pathology in a 35 years old woman who had a sensitiveness and eritematous tumor localized in the left breast. With the diagnosis of "mastitis", she was treated with antibiotics and corticoids for two weeks. Because the lesion and the sensitiveness persist and the mammographic and ecographic controls were suggestive of malignancy, the tumor was surgically removing. The histopathological diagnosis was idiopatic chronic granulomatous mastitis.
Assuntos
Adulto , Feminino , Humanos , Mastite Granulomatosa , Doença Crônica , Mastite Granulomatosa/patologia , Mastite Granulomatosa/cirurgiaRESUMO
Idiopathic chronic granulomatous mastitis is a rare disease in women at the reproductive life with clinic, mammographic, echographic and cytological characteristics suggestive of breast cancer. We report a case of breast pathology in a 35 years old woman who had a sensitiveness and eritematous tumor localized in the left breast. With the diagnosis of "mastitis", she was treated with antibiotics and corticoids for two weeks. Because the lesion and the sensitiveness persist and the mammographic and ecographic controls were suggestive of malignancy, the tumor was surgically removing. The histopathological diagnosis was idiopatic chronic granulomatous mastitis.